Annals for Hospitalists - 17 December 2019
Authors: David H. Wesorick, Vineet Chopra
Journal: Annals of Internal Medicine (2019)

Web ExclusivesDecember 17, 2019Annals for Hospitalists - 17 December 2019FREEDavid H. Wesorick, MD, Vineet Chopra, MD, MScDavid H. Wesorick, MDFrom Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (D.H.W, V.C)Search for more papers by this author, Vineet Chopra, MD, MScFrom Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (D.H.W, V.C)Search for more papers by this authorhttps://doi.org/10.7326/AWHO201912170 SectionsAboutVisual AbstractAbstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Inpatient NotesClinical Pearls: E-cigarette, or Vaping, Product Use–Associated Lung Injury—Isaac Ghinai, MBBS, BSc, MSc, and Jennifer E. Layden, MDIn recent months, more than 2000 cases of vaping-induced lung disease have been reported to the Centers for Disease Control and Prevention, including 39 deaths. In this article, investigators provide some clinical pearls about this emerging syndrome.Highlights of Recent Articles from Annals of Internal MedicineManagement of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus GroupAnn Intern Med. Published 22 October 2019. doi: 10.7326/M19-1795This article is an update to the 2010 International Consensus Recommendations on the management of nonvariceal upper gastrointestinal bleeding (UGIB). It focuses on resuscitation and risk assessment; preendoscopic, endoscopic, and pharmacologic management; and secondary prophylaxis for recurrent nonvariceal UGIB. The updated recommendations were developed by an international multidisciplinary group of experts who reviewed the available evidence.Key points for hospitalists include:Preendoscopic management recommendations include the use of a transfusion threshold of 8 g/dL hemoglobin for most patients and a higher (but unspecified) threshold for patients with cardiovascular disease.Endoscopic management recommendations include endoscopy within 24 hours of presentation for patients with acute GIB (endoscopy and endoscopic therapy should not be delayed for patients receiving anticoagulation therapy).Patients with low-risk stigmata (clean-based ulcer) can be fed within 24 hours and discharged with a once-daily proton-pump inhibitor (PPI). Those with high-risk stigmata (active bleeding, visible vessel) should remain hospitalized and treated with a high-dose PPI intravenously for 72 hours (i.e., loading dose followed by continuous infusion). High-risk patients should then be treated with an oral PPI, twice daily, for 14 days before changing to once-daily dosing.Secondary prophylaxis with PPIs is recommended for all patients with a history of bleeding ulcers who require continued nonsteroidal anti-inflammatory therapy (switching to cyclooxygenase-2 inhibitors should be considered), dual antiplatelet therapy (DAPT), or anticoagulation.An editorialist notes that some questions of importance to hospitalists, such as the optimal resuscitation strategy for upper GIB patients and the optimal PPI regimen before endoscopy, remain unanswered. In the Clinic: Obstructive Sleep ApneaAnn Intern Med. 2019;171:ITC65-ITC80.This narrative review article provides an update on the screening, prevention, diagnosis, and treatment of obstructive sleep apnea (OSA).Key points for hospitalists include:Loud, bothersome snoring; apnea; and oxygen desaturation during sleep are sometimes observed in hospitalized patients. These findings should prompt consideration of OSA.Several randomized trials have demonstrated that home sleep apnea testing (HSAT), followed by the initiation of treatment in the home, leads to outcomes similar to those of sleep laboratory testing for patients with uncomplicated OSA. HSAT measures several respiratory variables (e.g., oximetry, airflow, chest movement), but does not include electroencephalography. This technology has allowed some patients to be diagnosed and treated by their primary care providers without the need for a formal laboratory sleep study.Untreated OSA in the perioperative setting is associated with higher rates of cardiopulmonary complications and intensive care unit transfers.In patients with both OSA and hypertension, continuous positive airway presser (or mandibular advancement devices) can lead to reduced blood pressure, and these reductions are especially great in patients with treatment-refractory hypertension.The Latest Highlights From Journal ClubDoes a bundled intervention, including corticosteroids and targeted nutritional therapy, improve length of stay or mortality in patients hospitalized with community-acquired pneumonia?In inpatients with community-acquired pneumonia, a bundled intervention with steroids did not reduce length of stayAnn Intern Med. 2019;171:JC52. doi: 10.7326/ACPJ201911190-052This stepped-wedge cluster randomized controlled trial (RCT) compared patients receiving usual care to those receiving a bundled intervention (including prednisolone 50 mg/d for 7 days, early switch to oral antibiotics, early mobilization, and nutritional screening with targeted nutritional therapy). The 2 groups did not differ significantly for length of stay or mortality.After PCI and 3 months of DAPT, is P2Y12-inhibitor monotherapy inferior to continued DAPT?After PCI and 3 mo of DAPT, P2Y12-inhibitor monotherapy was noninferior to DAPT at 12 moAnn Intern Med. 2019;171:JC53. doi:10.7326/ACPJ201911190-053In this RCT, 2993 adults who received percutaneous cardiac intervention and completed 3 months of DAPT (with aspirin and a P2Y12 inhibitor) were randomly assigned to discontinue the aspirin or continue with both the aspirin and the P2Y12 inhibitor. Patients receiving P2Y12 inhibitor monotherapy did not experience any increase in major adverse cardiac events, all-cause death, stroke, or stent thrombosis at 12-month follow-up and had significantly less minor bleeding than patients who continued DAPT.Sign up here to have Annals for Hospitalists delivered to your inbox each month. Comments0 CommentsSign In to Submit A Comment PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists Inpatient Notes - Clinical Pearls—E-Cigarette, or Vaping, Product Use–Associated Lung Injury Isaac Ghinai and Jennifer E. Layden Metrics December 17, 2019Volume 171, Issue 12Page: ED12KeywordsCardiovascular diseasesPneumoniaProphylaxisHemoglobinAntiplatelet therapyHypertensionInpatientsResearch laboratoriesHospitalistsSleepHemorrhageResuscitationEndoscopySleep apneaPercutaneous coronary interventionUlcersApneaNutritionLungs Issue Published: December 17, 2019 CopyrightCopyright © 2019 by American College of Physicians. All Rights Reserved.Loading ...